Payment Integrity Auditor

September 19

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CorroHealth

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Revenue Cycle Management • Revenue Integrity • Healthcare Data and Analytics

5001 - 10000

Description

• Performs quality oversight for complex retrospective analysis of medical record documentation to identify coding and billing errors and inconsistencies according to guidelines of the AHA, CMS, AMA, Clinic Coding Clinic and CPT Assistant. • Analyzes audit findings to identify potential root causes of coding errors and prevent their reoccurrence by internal team. • Support in service line kick off and training sessions. • Provides second –level review of diagnosis, procedure and billing codes to ensure compliance with legal and procedural policies that ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices. • Research, analyze and respond to inquiries regarding compliance, inappropriate coding, denials and billable services related to payment integrity team members. • Provides technical support and feedback training to internal coding staff regarding coding compliance, documentation, regulatory provisions, third part payer requirements, medical necessity requirements. • Protects the privacy and confidentiality of patient health and client information. • Follows the Standards of Ethical Coding as set forth by AHIMA and adheres to official coding guidelines and compliance practices. • Prepare deliverables for the clients as required. • Report work time and work productions in a timely and accurate manner. • Communicates with coworkers in an open and respectful manner which promotes teamwork and knowledge sharing. • Provide schedule of planned work activities, events and sites, and any changes to same to management and appropriate staff. • Maintenance of professional coding credentials and knowledge of coding, reimbursement methodologies and compliance issues through education.

Requirements

• Recognized coding credential from AHIMA or AAPC; and RHIA or RHIT may also be considered. • Experience with telecommuting and electronic medical records systems strongly preferred. • Strong analytical skills. • Excellent written communication skills. • Strong team player. • Ability to work with multiple and diverse clients and projects. • Ability to work with minimal supervision. • Training and education experience preferred. • 5-7 years’ experience coding and/or auditing in an acute care facility or clinic, of patient types listed in the Job Summary of this document.